RSS Feedhttp://10.40.239.128/blogs/rss-feed/Blog RSS Feeden{6B6FBE02-BA91-4D4B-A8B3-F39E80C8EFF7}http://10.40.239.128/blogs/2014/11/hunter-safety/Hunter Safety<strong style="line-height: 22.3999996185303px;">Safety Tips for Hunters from USDA</strong><br style="line-height: 22.3999996185303px;" />
<ul style="line-height: 22.3999996185303px;">
<li>Check weather reports before visiting the forest.</li>
<li>Tell someone where you will be hunting and when you will return.</li>
<li>Be familiar with the area you want to hunt.</li>
<li>Dress properly and be prepared for the worst possible conditions.</li>
<li>During certain seasons, hunters must wear hunter orange viewable from all directions.If accompanied by a dog, the dog should also wear hunter orange or a very visible color on a&nbsp;vest, leash, coat or bandana.</li>
<li>Check hunting equipment before and after each outing, and maintain it properly. Familiarize&nbsp;yourself with its operation before using it in the field.</li>
<li>Carry a spare set of dry clothing. Use layering techniques to prevent moisture while retaining&nbsp;body warmth. Always bring rain gear.</li>
<li>Carry a first aid kit.</li>
<li>Clearly identify your target before shooting. Prevent unfortunate accidents or fatalities.</li>
<li>Put hunting plans in writing (dates, times, location and expected time of return). Putting plans&nbsp;in writing; leaving one at home and one on your vehicle.</li>
<li>Be alert when hunting near developed areas and trails. Other recreationists are in the forest as&nbsp;well.</li>
<li>Avoid wearing white or tan during deer season. Wear hunter orange or another highly visible&nbsp;color.&nbsp;</li>
</ul>
<p style="line-height: 22.3999996185303px;"><strong>Safety Tips for Nonhunters&nbsp;visiting the National Forests</strong></p>
Wear bright clothing. Make yourself more visible. Choose colors that stand out, like red, orange<br style="line-height: 22.3999996185303px;" />
<p style="line-height: 22.3999996185303px;">or green, and avoid white, blacks, browns, earth-toned&nbsp;greens and animal-colored&nbsp;clothing.&nbsp;Orange vests and hats are advisable.</p>
<ul style="line-height: 22.3999996185303px;">
<li>Don&rsquo;t forget to protect your dog. Get an orange vest for your dog if he/she accompanies you.</li>
<li>Make noise. Whistle, sing or carry on a conversation as you walk to alert hunters to your&nbsp;presence. Sound carries well across mountain basins, and hunters should be listening for any&nbsp;sounds of animal movement.</li>
<li>Be courteous. Once a hunter is aware of your presence, don&rsquo;t make unnecessary noise to&nbsp;disturb wildlife. Avoid confrontations.</li>
<li>Make yourself known. If you do hear shooting, raise your voice and let hunters know that you&nbsp;are in the vicinity.</li>
<li>Know when hunting seasons are. Continue to hike, but learn about where and when hunting is&nbsp;taking place.</li>
</ul>
<p style="line-height: 22.3999996185303px;"><strong>NRA Gun Safety Rules</strong></p>
<p>Available as a brochure, the fundamental NRA rules for safe gun handling are:</p>
<ol style="line-height: 22.3999996185303px;">
<li>ALWAYS keep the gun pointed in a safe direction.&nbsp;This is the primary rule of gun safety. A safe direction means that the gun is pointed so that even&nbsp;if it were to go off it would not cause injury or damage. The key to this rule is to control where the&nbsp;muzzle or front end of the barrel is pointed at all times. Common sense dictates the safestdirection, depending on different circumstances.</li>
<li>ALWAYS keep your finger off the trigger until ready to shoot.&nbsp;When holding a gun, rest your finger on the trigger guard or along the side of the gun. Until you&nbsp;are actually ready to fire, do not touch the trigger.</li>
<li>ALWAYS keep the gun unloaded until ready to use.&nbsp;Whenever you pick up a gun, immediately engage the safety device if possible, and, if the gun&nbsp;has a magazine, remove it before opening the action and looking into the chamber(s) which&nbsp;should be clear of ammunition. If you do not know how to open the action or inspect the&nbsp;chamber(s), leave the gun alone and get help from someone who does.</li>
</ol>
<p style="line-height: 22.3999996185303px;">Know your target and what is beyond.&nbsp;Be absolutely sure you have identified your target beyond any doubt. Equally important, be aware&nbsp;of the area beyond your target. This means observing your prospective area of fire before you&nbsp;shoot. Never fire in a direction in which there are people or any other potential for mishap. Think&nbsp;first. Shoot second.</p>
<div><br />
</div>Mon, 03 Nov 2014 00:00:00 -0700{B6F84E74-9370-4977-BD68-2CA2467150A3}http://10.40.239.128/blogs/2014/10/a-healthier-halloween/Have A Healthier Halloween<p>While you can't necessarily control the type or amount of candy your kids accumulate during the night, you do have some control over the candy you buy for your home to pass out to trick-or-treaters and how much of that candy your kids (and you) eat after the fact.&nbsp;Here are some quick tips to help you and your family have a healthier Halloween:</p>
<p> </p>
<p> </p>
<p><strong>Control what you buy</strong></p>
<p>
</p>
<ol>
<li>Purchase healthier food options to pass out: peanuts, sunflower or pumpkin seeds, trail mix, fruit leathers, light popcorn, pretzels, whole wheat crackers, low fat pudding cups, 100% fruit juice boxes, gum, or turn a clementine into a jack-o-lantern with a permanent marker. &nbsp;</li>
<li>Pass out non-food items like&nbsp;temporary tattoos, stickers, 'fangs,' pencils or erasers.&nbsp;Kids often enjoy these items just as much or more.</li>
<li>Some of your best candy choices: PayDay is the winner because it is low in saturated fat and 3 grams of protein per bar, Reece's Peanut butter cups also are relatively low in saturated fat with some protein too. Twizzlers are a decent option. Tootsie pops, blow pops, and Gobstoppers are mostly sugar, but take longer to eat so can limit amounts consumed.</li>
<li>Some of your worst options are Mounds, Whoppers, Kit Kats, Reese's Pieces, which are high in calories and fat - of which is mostly saturated fat. M&amp;Ms (even peanut) are high in saturated fat as well and tend to be consumed in higher amounts. Skittles and Starbursts are also high in saturated fat.&nbsp;</li>
</ol>
<p> </p>
<p><strong>Ideas for managing candy after Halloween:</strong></p>
<p>
</p>
<ol>
<li>Halloween night, have children sort candy into two piles - candy they like and candy they don't like. Let them keep the candy they like and give the candy they don't like away by donating it to a food bank or to a program who sends candy to US troops overseas.</li>
<li>Allot a certain amount of candy for children to consume daily - allow them to choose what candy they want, when they want it as long as they are under the limit.&nbsp;</li>
<li>Freeze leftover candy and pull out only what is needed.&nbsp;</li>
<li>Keep candy out of sight in a drawer or cupboard (out of sight, out of mind).</li>
<li>Toss leftover candy or donate it once your children lose interest.&nbsp;</li>
<li>Finally, resist the urge to buy candy on sale the day after Halloween.&nbsp;</li>
</ol>
<p> </p>Wed, 29 Oct 2014 00:00:00 -0600{4F64A005-A07B-4F57-A95E-26256941146B}http://10.40.239.128/blogs/2014/10/running-blog-october-2014/Are You Ready to Run?<p style="margin: 0in 0in 10pt;">Having participated in a few marathons over the past 8 years I have had the opportunity of reading hundreds of different signs that spectators were holding up in an effort to both entertain and inspire those who were running. One of my favorites read as follows: </p>
<p style="text-align: center; margin: 0in 0in 10pt;"><b>&ldquo;Any idiot can run. But it takes a special kind of idiot to run a marathon. Go Dad!&rdquo;</b></p>
<p style="margin: 0in 0in 10pt;">I mention this, not only because it is funny, but because it presents what I believe to be a serious misconception about running. And that is that running is easy and really doesn&rsquo;t involve much skill or knowledge to do it correctly. Anybody can do it. All you have to do is put on a pair of running shoes and start running, right? Wrong. But unfortunately this is the approach that a lot of people take. For a variety of different reasons people become motivated to start running. And so, with good intentions, they put on their shoes and they start running. &nbsp;It is usually about 2-4 weeks after they start that they find themselves frustrated and sitting in their medical provider&rsquo;s office seeking treatment for some part of their body that is hurting. As a physical therapist I have seen this scenario played out over and over again. My experience as both a physical therapist and as a runner has taught me that there is actually quite a bit to learn about the techniques one can employ to enable them to run in a way that increases their efficiency and reduces the risk of injury. &nbsp;So whether you are starting a new program or looking to improve your current running technique here are four simple tips to keep in mind:</p>
<p style="margin: 0in 0in 10pt;">First, implement changes slowly. Whether you haven&rsquo;t run in years and are planning on starting, or if you are currently running consistently and just want to increase your speed or mileage, DO IT SLOWLY! Remember, your body&rsquo;s tissues (muscles, tendons, bones, ligaments, nerves, etc.) take time to adapt to the new stresses being placed upon them.&nbsp;&nbsp; If you do too much too quickly the daily &ldquo;breakdown&rdquo; of the tissues exceeds the daily &ldquo;repairs&rdquo; your body is trying to implement.&nbsp; Try thinking of your body as a balance or scale with the &ldquo;breakdown&rdquo; on one side and the &ldquo;repair&rdquo; on the other side. If the amount of breakdown consistently exceeds the amount of repair, the scale starts to be out of balance. When the tissues of your body get far enough &ldquo;out of balance&rdquo; you will start to experience pain and inflammation. If not addressed properly this can lead to more serious problems such as joint pain and swelling, strained muscles, tendinitis, bursitis and even stress fractures. </p>
<p style="margin: 0in 0in 10pt;">Second, be mindful of your cadence. Cadence refers to the number of steps per minute you are taking while you run. The cadence that a lot of coaches and elite runners like to aim for is about 180 steps a minute. This translates into 3 steps every second. &nbsp;One big mistake that runners often make is over striding which increases the impact on their heels when they strike the ground. Keeping your cadence in the ballpark of about 180 steps a minute helps to reduce your stride length and lessens the impact felt when the foot hits the ground. Less impact translates into less breakdown of the body&rsquo;s tissues over time and helps to reduce the risk of injury.</p>
<p style="margin: 0in 0in 10pt;">&nbsp;</p>
<p style="margin: 0in 0in 10pt;">Third, get your &ldquo;butt&rdquo; in gear. The gluteus maximus or buttock muscle is one of the biggest muscles in the body. You should be using this muscle to your advantage when you run. If used appropriately the gluteus maximus can help to stabilize your trunk, reduce the workloads placed on your quadriceps and hamstring muscles, and help support and reduce the amount of strain on your low back. The way to do this is to contract or squeeze your ipsilateral (same sided) buttock muscle just as your foot strikes the ground and hold this contraction or squeeze until your foot leaves the ground. For example, when your right foot strikes the ground, you would squeeze your right buttock tight and hold it as your body passes over your right foot and then relax the contraction as you lift your right foot off the ground. The same process would then be repeated on the left side.</p>
<p style="margin: 0in 0in 10pt;">And finally, run quietly. Perhaps you have never really listened to yourself run. If so, take time to turn off the music, take out the earplugs and listen to the sound of your feet hitting the ground. Many runners first make contact on the back of their heel while keeping the toes pointed up off the ground. Their momentum then causes their toes to accelerate down and slap hard against the ground. In an effort to minimize this &ldquo;foot slap&rdquo; the muscles on the front of the shin can get overworked, leading to a condition commonly referred to as &ldquo;shin splints". A good way to eliminate this is to pretend you are sneaking up on someone as you run and you don&rsquo;t want them to hear you coming. In order to run quietly, you must move the initial point of contact for your foot from the back of the heel to the area just in front of the heel. This is called a mid-foot strike and it helps reduce the stresses, as well as the noise, associated with foot slap.</p>
<p style="margin: 0in 0in 10pt;">I know from personal experience that nothing is more frustrating than to set a personal goal, to be excited and diligent about working toward that goal, only to have it thwarted by the pain and limitations of nagging injuries. While these four simple tips are not a conclusive list, by any means, they can help lay a solid foundation upon which to build. But remember, just like any other sport, it takes a lot of learning and a lot of practice to become an efficient runner.</p>Tue, 28 Oct 2014 00:00:00 -0600{23CCED78-A001-4BAD-90FD-5CBB938B7F5E}http://10.40.239.128/blogs/2014/10/halloween-safety-refresher/Halloween Safety Refresher​Here are some simple safety tips from the Safe Kids Organization: <div><br /></div>
<div><strong>Child Pedestrians </strong></div>
<div><ul><li><span style="line-height:1.4">Children under 12 should trick-or-treat and cross streets with an adult. Send older children in groups.</span><br /></li>
<li><span style="line-height:1.4">Always walk on sidewalks or paths. If there are no sidewalks, walk facing traffic as far to the left as possible. </span><br /></li>
<li><span style="line-height:1.4">Cross the street at corners, using traffic signals and crosswalks. Parents should remind children to watch for cars that are turning or backing up. </span><br /></li>
<li><span style="line-height:1.4">Look left, right and left again when crossing and keep looking as you cross. Walk; don’t run, across the street. </span><br /></li>
<li><span style="line-height:1.4">Remind children not to talk to or accept rides from strangers.</span><br /></li></ul></div>
<div><strong style="line-height:1.4">Drivers </strong><br /></div>
<div><ul><li><span style="line-height:1.4">Slow down and be especially alert in residential neighborhoods. Children are excited on Halloween and may move in unpredictable ways. </span><br /></li>
<li><span style="line-height:1.4">Anticipate heavy pedestrian traffic and turn your headlights on earlier in the day so you can spot children from greater distances. </span><br /></li>
<li><span style="line-height:1.4">Remember that costumes can limit children’s visibility and they may not be able to see your vehicle. </span><br /></li>
<li><span style="line-height:1.4">Reduce any distractions inside your car so you can concentrate on the road and your surroundings. </span></li></ul>
<span style="line-height:1.4"><strong>Costumes and Treats </strong></span><br /><ul>
<li><span style="line-height:1.4">Decorate costumes and bags with reflective tape or stickers and choose light colored costumes to improve visibility. </span><br /></li>
<li><span style="line-height:1.4">Choose face paint and make-up instead of masks, which can obstruct a child’s vision. Look for non-toxic designations when choosing Halloween makeup. </span><br /></li>
<li><span style="line-height:1.4">Avoid carrying sticks, swords, or other sharp objects. </span><br /></li>
<li><span style="line-height:1.4">Have kids carry glow sticks or flashlights in order to see better, as well as to be seen by drivers. Liquid in glow sticks is hazardous, so parents should remind children not to chew on or break them. </span><br /></li>
<li><span style="line-height:1.4">Check treats for signs of tampering before children are allowed to eat them. Candy should be thrown away if the wrapper is faded or torn, or if the candy is unwrapped. Examine treats before allowing children to eat them.</span><br /></li></ul></div>
<div><br /></div>
<div>For more information visit: <a href="http://www.safekids.org/tip/halloween-safety-tips">http://www.safekids.org/tip/halloween-safety-tips</a></div>
<div><br /></div>
Tue, 28 Oct 2014 00:00:00 -0600{0B043914-9C1E-4C70-9301-E25AD8A4B8BB}http://10.40.239.128/blogs/2014/10/heart-attacks-genes-or-lifestyle/Heart Attacks: Genes or Lifestyle?Heart attacks aren&rsquo;t as connected to family history and genetics as strongly as may have been previously believed, according to a new study by researchers at the Intermountain Medical Center Heart Institute.&nbsp;<br />
<br />
The new findings may help those with a family history of coronary disease and those diagnosed with narrow coronary arteries realize heart attacks aren&rsquo;t inevitable and their lifestyle choices and environment, not just their genetics, may make the difference in whether or not they have a heart attack, say researchers.<br />
<br />
<strong>How the study was conducted.</strong> In the study, Ben Horne, PhD, MPH, Director of Cardiovascular and Genetic Epidemiology at the Intermountain Heart Institute, and his team studied patients with different severities of coronary disease who had or hadn&rsquo;t suffered a heart attack. The patients were identified by linking 700,000 patients in Intermountain Healthcare&rsquo;s clinical data warehouse with the Intermountain Genealogy Registry, which contains 23 million individuals within extended family pedigrees.<br />
<br />
The research team found that while severe coronary artery disease can be inherited regardless of whether someone has a heart attack, the presence of heart attacks in people with less severe coronary disease wasn&rsquo;t clustered in families. &ldquo;This link between the registry and the medical records allowed us to look at information about both heart attacks and the degree of coronary disease,&rdquo; says Dr. Horne. &ldquo;That means we can compare heart attack patients to people with coronary disease who were free from heart attacks.&rdquo;<br />
<br />
Dr. Horne and his team presented their findings a week ago at the 2014 conference of the American Society of Human Genetics.<br />
<br />
<strong>Two reasons their research is important:</strong> First, it can help physicians and researchers look for triggers or risk factors for heart attacks that result from behaviors or environmental factors rather than genetic ones. Second, it can help researchers better design genetic studies focused on heart attacks so they can best utilize the resources they have to find the limited set of genetic mutations that are actually involved in predisposing people to heart attack.<br />
<br />
&ldquo;Because coronary disease and heart attacks are so closely related, researchers in the past have assumed they&rsquo;re the same thing,&rdquo; Dr. Horne says. &ldquo;They thought if someone had coronary disease, they&rsquo;d eventually have a heart attack. This finding may help people realize that, through their choices, they have greater control over whether they ultimately have a heart attack.&rdquo;<br />
<br />
The idea for Dr. Horne to study the connection between heart attacks and family history began in 2008 when researchers found genetic factors related to chromosome 9 were strongly connected to coronary artery disease, but those same mutations had no connection to heart attacks. That supported the biological understanding that a heart attack is different than coronary disease, where a heart attack results when the atherosclerosis causing coronary disease is unstable. Some atherosclerosis is stable and won&rsquo;t result in a heart attack.<br />
<br />
&ldquo;Although in almost all situations someone needs to have some level of coronary disease in order to have a heart attack, some people will have a heart attack when they only have mild coronary disease, where there&rsquo;s only a small amount of narrowing of the artery &mdash; while others will have a heart attack with severe coronary narrowing,&rdquo; Dr. Horne says.<br />
<br />
More details about the link between genetic mutations and heart attacks. In 2011, Dr. Horne and his team were part of an international genome-wide association study run by the University of Pennsylvania that validated that the chromosome 9 mutation &mdash; and the 10 other genetic mutations also known at the time to be predictors of coronary disease &mdash; didn&rsquo;t predict heart attacks.<br />
<br />
&ldquo;The 2011 study was only able to find one genetic mutation associated with heart attack among people with coronary disease,&rdquo; says Dr. Horne. &ldquo;As researchers continued to find more connections to coronary disease but not specifically to heart attacks, we started wondering if we&rsquo;d find the same within family pedigrees.&rdquo;<br />
<br />
Three years later researchers have found 35 more genetic mutations ­&ndash;&ndash; for a total of 46 &ndash;&ndash; generally accepted to be associated with coronary disease. The studies that have discovered these connections have evaluated unrelated people in large populations.<br />
<br />
&ldquo;These findings also show how Intermountain Healthcare is able to leverage the strengths of the local community in Utah, including genealogical resources, databases via medical informatics technology, and the involvement of community members to perform valuable, unique research few others can do,&rdquo; says Dr. Horne. &ldquo;These resources help us find new knowledge that has widespread, world-wide relevance in helping people avoid health risks and improve their quality of life. We&rsquo;re also grateful to the Intermountain Research and Medical Foundation for providing the financial support necessary to conduct this study.&rdquo;<br />
<br />
Members of the Intermountain Medical Center Heart Institute research team include Stacey Knight, PhD, MStat, Jeffrey Anderson, MD, Brent Muhlestein, MD, and John Carlquist, PhD.Mon, 27 Oct 2014 00:00:00 -0600{A2F296EF-4F35-44FF-B553-1331D0E9F5F5}http://10.40.239.128/blogs/2014/10/improving-patient-care-in-hospital-intensive-care-units/Improving Patient Care in Hospital Intensive Care Units<p>Dr. Brown said the research is driven by the reality that many patients survive life-threatening illnesses and injuries treated in the ICU but then suffer significant psychological distress, including post-traumatic stress disorder, some of which relates to the way intensive care is delivered. Similar emotional distress often affects family members as well as patients.</p>
<p>&ldquo;The technologies of intensive care in this country have advanced to an astonishing level, in terms of what we can do to treat people with life-threatening illnesses or injuries,&rdquo; said Dr. Brown. &ldquo;We&rsquo;ve developed powerful medications, life support technologies, surgical techniques, and organizational principles that routinely save people who would&rsquo;ve died of their illnesses just a few years ago. But we haven&rsquo;t done a good job in figuring out how to make the ICUs more humane places, where dignity is preserved and patients and their families can feel more in control of what is happening to them during a frightening period in their lives.&rdquo;</p>
<p>Dr. Brown, director of the Center for Humanizing Critical Care at Intermountain Healthcare, is involved in a number of research studies aimed at making medical care of acute life-threatening illness and injury more humane and patient-centered.</p>
<p>In various collaborations and initiatives, Center researchers are working to understand differences in how people process stressful situations like an ICU admission, how to fix advance directives (&ldquo;living wills&rdquo;) to make them useful in real situations, how to help people recover strength, mental and psychological health after an ICU admission and how to help people process the decisions that arise during the course of an ICU stay.</p>
<p>Dr. Brown recently signed a contract with Oxford University Press for a book outlining his vision for the ICU of the future. &ldquo;We have an incredible opportunity to re-shape the way intensive care is delivered at Intermountain and across the country,&rdquo; he said. &ldquo;I hope this book will foster conversations that will dramatically advance that change."</p>
In his own words, Dr Brown explains his inspiration and thoughts on why humanizing the ICU is important for patient-centered care across the nation.<br />
<p><br />
</p>
<iframe width="700" height="394" src="//www.youtube.com/embed/oQ5ydR2DN2w" frameborder="0"></iframe>Fri, 24 Oct 2014 00:00:00 -0600{3307B3B7-6A1E-4715-8179-56B994578AC6}http://10.40.239.128/blogs/2014/10/life-flight-opens-new-maternal-transport-service/Life Flight Opens New Maternal Transport Service&ldquo;The whole goal of our maternal team is to keep the baby in the oven,&rdquo; says Carol Rhoades, RN, MSN, Life Flight&rsquo;s Nursing Director. &ldquo;We&rsquo;ll do ground and air transports for women who are suffering from conditions ranging from pre-term labor, preeclampsia, or preterm premature rupture of the membranes to complicated maternal surgical or medical issues. And if the patient has the potential for delivery we&rsquo;ll take a newborn nurse with us so we can resuscitate the baby.&rdquo;<br />
<br />
<strong>What&rsquo;s a typical case like &mdash; and how does the new service benefit the community?</strong><br />
A typical case involves transporting a high-risk mom or baby to a facility that can provide specialized obstetrical or neonatal care. &ldquo;We have the ability to provide swift, specialized intervention by bringing highly-skilled personnel and equipment to the referring facility,&rdquo; Carol says. &ldquo;We can also transport via ambulance if time isn&rsquo;t as important. We recognize the high cost of helicopter transports and ground transport is a less expensive alternative when the need for speed isn&rsquo;t in the equation. Our maternal/fetal medicine physicians will collaborate with<br />
referring MDs to make that decision.&rdquo;<br />
<br />
The team is staffed by 11 specially-trained labor-and-delivery nurses from Intermountain Medical Center in Salt Lake City, 10 from Utah Valley Regional Medical Center in Provo, and 10 from Dixie Regional Medical Center in St. George. Dixie&rsquo;s program will start up in November.<br />
<br />
<p>&ldquo;They&rsquo;ll continue to work in their Labor and Delivery jobs, and when we get a call they&rsquo;ll run out to the helicopter and jump on,&rdquo; Carol says. &ldquo;The community will benefit because we&rsquo;re located across the state rather than centralized. That puts us that much closer to getting a skilled and experienced team to mom and moving her to a hospital with additional resources. In addition, there&rsquo;s only one other specialized high-risk OB team in the region, so if they&rsquo;re on a transport there&rsquo;s no back-up. Now pregnant patients throughout the West have faster access to high-risk obstetrical nurses.&rdquo;</p>
&ldquo;I&rsquo;m incredibly impressed with the experience level of the nurses on our team,&rdquo; she adds. &ldquo;I think our team members average well over 10 years of labor-and-delivery experience. We have a very seasoned, very professional group of nurses.&rdquo;<br />
<br />
<strong>What was it like to be on one of our first flights?</strong><br />
Life Flight&rsquo;s new high-risk OB team was projected to care for between 70 and 100 patients a year, but they completed their first transport just three hours after the new service opened on September 18, and in their first week of service, they transported three patients. Shelley Jackman,RN, was the OB nurse on the first flight for the Intermountain Medical Center team. &ldquo;The flight went very smoothly,&rdquo; she says. &ldquo;The patient was darling but scared to death, and I was able to be a nurse and comforter all at the same time. It was very rewarding. I&rsquo;m really enjoying this new adventure at work.&rdquo;<br />
<br />
Shauna Hepworth, RN, Manager of Labor and Delivery at Intermountain Medical Center, says: &ldquo;From a management perspective, we&rsquo;re proud and excited to have this new team of capable labor-and-delivery nurses working in tandem with the Life Flight adult and neonatal teams to provide high-risk obstetric transport services to our community and the surrounding areas.&rdquo;Fri, 24 Oct 2014 00:00:00 -0600{F75CBA5C-5BF2-480B-A20C-BC755814F240}http://10.40.239.128/blogs/2014/10/rsv-when-its-more-than-just-a-cold/RSV: When It&#39;s More Than Just A Cold<p style="margin: 0in 0in 10pt;"><b>RSV: When it&rsquo;s more than Just a Cold</b></p>
<p style="margin: 0in 0in 10pt;"><b>What is RSV?</b></p>
<ul>
<li>RSV looks and sounds like a cold, but RSV or respiratory syncytial virus can become something more. What&rsquo;s the difference? What should you do about it as parents? And when should you take your child to the pediatrician/Dr?</li>
<li>Kids at Risk for RSV: being born prematurely (or preterm) or a child who has a condition affecting their lungs, heart, or immune system</li>
<li>RSV is highly contagious and a typical season is roughly November-April. It can be spread directly from person to person, or indirectly when someone touches any object infected with the virus, such as toys, countertops, doorknobs, or pens/pencils. Kids under two are especially ill as a result of this virus.&nbsp; </li>
</ul>
<p style="margin: 0in 0in 10pt;"><b>What to do?</b></p>
<ul>
<li>Prevent the Spread: teach and spread good hand washing</li>
<li>Keep children at risk from child care centers during peak RSV season if you have a child at risk</li>
<li>Kids can shed virus for about a week. Also steer clear of tobacco smoke: Parents who smoke are more apt to acquire viral respiratory infections and pass them onto their children.</li>
</ul>
<p style="margin: 0in 0in 10pt;"><b>Diagnosis and Treatment:</b></p>
<ul>
<li>Because RSV is a virus rather than a bacterial infection, it cannot be treated with antibiotics, and there is no vaccine available yet but is being worked on</li>
<li>Diagnosed by taking a swab of the nasal fluids in the Dr&rsquo;s office</li>
<li>There is a shot to prevent RSV for the very high risk infants, however it is very expensive and requires strict criteria be met before insurance will pay for it</li>
<li>Give plenty of fluids</li>
<li>Use cool-mist vaporizer during winter months to keep air moist. Blow little noses frequently (or use a nasal aspirator for infants)</li>
<li>Give non-aspirin pain reliever, such as acetaminophen. Aspirin should be avoided as it is linked to Reye syndrome.</li>
</ul>
<p><b>When to call the Doctor:</b></p>
<p><b></b></p>
<ul>
<li>Difficulty breathing or fast breathing pattern</li>
<li>Excessive wheezing</li>
<li>Gray or blue skin color</li>
<li>High fever</li>
<li>Thick nasal discharge that is yellow, green or gray</li>
<li>Extreme tiredness (especially during times of typical activity)</li>
</ul>Tue, 21 Oct 2014 00:00:00 -0600{A0636408-A4AF-4085-996B-17EC2CBE3F61}http://10.40.239.128/blogs/2014/10/medications-used-for-treating-diabetes/Medications Used for Treating Diabetes<p style="margin: 0in 0in 10pt;">Proper nutrition, exercise, and stress management are all parts of a self-management plan for people with diabetes.&nbsp; In addition to self-management, people with type 2 diabetes often times need medication to control blood glucose.</p>
<p style="margin: 0in 0in 10pt;">Oral medications will not cure diabetes but they work in different ways to help lower blood glucose in people with type 2 diabetes.&nbsp; Some people may only need one medication while others may need a combination of two or three medications.&nbsp; Some diabetes pills also come in a single pill that combines two medications.&nbsp; </p>
<p style="margin: 0in 0in 10pt;">Oral diabetes medications work to lower blood glucose by&hellip;..</p>
<ul>
<li>Decreasing the amount of glucose released by the liver</li>
<li>Stimulating the pancreas to produce more insulin</li>
<li>Making the body&rsquo;s cell more receptive to insulin</li>
<li>Slowing the digestion and absorption of carbohydrates</li>
</ul>
<p style="margin: 0in 0in 10pt;">Over time your diabetes will probably change and what you are doing today may not work.&nbsp; That does not mean that you have done anything wrong, it can just be part of the disease process.&nbsp; At this point it is important to look at what adjustments need to be made.&nbsp; If you are doing everything you can related to nutrition and exercise it may require a change in medication and possibly taking insulin.&nbsp; Insulin must be taken by an injection.&nbsp; When a person with type 2 diabetes needs to take insulin injections it does not mean failure, it is just another way to treat type 2 diabetes.</p>
<p style="margin: 0in 0in 10pt;">Type 2 diabetes is a complex disease so it is important to work with your team to manage your diabetes.&nbsp; Diabetes educators are part of that team and we are anxious to help you and make life with diabetes a little easier.</p>Tue, 21 Oct 2014 00:00:00 -0600{EBD8FFBE-E17C-45A2-830A-E5595FE35FD0}http://10.40.239.128/blogs/2014/10/oral-immunotherapy-for-peanut-allergy/Oral Immunotherapy for Peanut Allergy<p style="margin: 0in 0in 10pt;">Recently there has been a great deal of interest in local and national media about how peanut allergic patients can overcome their allergy enabling them to eat peanuts without worry of reaction.&nbsp; Oral food desensitization is a potentially exciting and even liberating concept.&nbsp; But like many issues in health care, there are potential pros and cons that are being uncovered as studies go forward, including safety, cost, side effects, candidate foods, convenience, etc. that remain unclear or unanswered.&nbsp; This article details some of our findings on both sides of the issue to date.</p>
<p style="margin: 0in 0in 10pt;"><strong>What is the science of oral food immunotherapy?</strong>&nbsp; By way of background, 4-5% of the US population is allergic to foods and 1-3% are allergic to peanuts.&nbsp; The annual death from food anaphylaxis is estimated to be 150-200/year, 67% caused by peanuts.&nbsp; This represents 1 death per every 24,000 peanut allergic patients/year.&nbsp; Most people who die from peanuts knew they were allergic, and most did not have their epinephrine on hand.&nbsp; Other than death, 1.6% of peanut allergic persons have a severe reaction to accidental peanut exposure/year, and &nbsp;1.1% of peanut allergic persons require&nbsp; epinephrine per year.&nbsp; Spontaneous loss of peanut allergy occurs in 4% of peanut allergic children each year, and cumulative remissions over 7-8 years is 22-34%</p>
<p style="margin: 0in 0in 10pt;"><strong>What is the status of clinical studies on peanut OIT to date?</strong>&nbsp; In this country we have a few select centers of excellence that are independently funded and equipped to conduct academically robust clinical trials to answer questions of peanut and other food allergy immunotherapy.&nbsp; While protocols vary somewhat from institution to institution, there are some general approaches that are part of these investigations.&nbsp; Protocols to study peanut oral immunotherapy generally include:</p>
<ol>
<li>&nbsp;A one day escalation phase (0.1 mg doubling every 30 minutes to a certain maximum, often 50 mg.&nbsp; For reference, one peanut contains about 180 to 200 mg of peanut protein allergen.&nbsp; During this phase, 50% or more develop significant and sometimes serious adverse events, and most experience a 10% dropout rate.</li>
<li>A maintenance phase where over several months there is a step increase 25-50 mg every few weeks to achieve a daily maintenance dose, generally 1800 to 4,000 mg/day (9 to 20 peanuts).&nbsp; This phase is maintained variably for months to 3 years.&nbsp; During this time, 50% of patients experience adverse effects.&nbsp; Studies indicate that around 85% of study patients can achieve this dose on an ongoing basis.</li>
<li>A challenge test on while on maintenance (usually 4000-5000 mg peanut protein) to demonstrate true tolerance to peanuts.</li>
<li>A discontinuation phase where oral peanuts are stopped, and generally 2-3 months later patients undergo another oral challenge to determine if they remain truly desensitized.&nbsp; While studies vary, such oral challenges are associated with a 50-80% pass rate, but this seems to decline with additional time and subjects become susceptible again to serious reactions.&nbsp; &nbsp;</li>
</ol>
<p style="margin: 0in 0in 10pt;">Adverse effects and complications may occur as a consequence of peanut OIT.&nbsp; In one study, 12% of peanut allergic patients required epinephrine during escalation phase, and 6% of patients during maintenance.&nbsp; Recently, there is concern about a rising prevalence of eosinophilic esophagitis (EoE) in oral peanut desensitized patients.&nbsp;&nbsp; EoE is a disorder of the food tube characterized by marked infiltration of a particular type of WBC (eosinophil) that can lead to pain, narrowing and chronic inflammation.&nbsp; The incidence in of EoE in the general population is 1/10,000, while the incidence in a peanut OIT study was 10% of patients given oral peanut immunotherapy.&nbsp; Other oral and GI side effects, wheezing, worsening asthma, anaphylaxis have been shown to worsen or evolve in some patients.&nbsp; Outcomes studies seem to indicate that peanut OIT does not lead to cure, and continuous exposure to peanuts is likely needed to sustain desensitization.</p>
<p style="margin: 0in 0in 10pt;">At the center of increasing interest in using peanut OIT in routine clinical practice is a recently published paper by Wasserman et al.&nbsp; This study consists of a retrospective chart review of 352 patients who underwent peanut OIT in 5 different practices. &nbsp;They found an 85% success in desensitization to peanut.&nbsp; Since this review was retrospective, the article has some flaws inherent in such studies. &nbsp;&nbsp;In general, selection criteria from different centers were not well defined, methods varied considerably from center to center, targeted maintenance doses varied from 415 to 8000 mg of peanut protein, and the maintenance period was variable.&nbsp; Reactions requiring epinephrine were required in 0.7 of 1000 doses during escalation, and 0.2 of 100 doses during maintenance.&nbsp; There was a 5% drop out rate of those on maintenance.&nbsp; While a helpful review, several problems were noted with the methods and outcomes, including an enormous range of maintenance dosing, patients on treatment were twice as likely to require epinephrine than untreated patients, no long term reduction in reactions from accidental exposures was determined, there was no data on less-severe reactions or reactions that required treatment with other medications or required ER visits, the risk of EoE in patients treated with peanut OIT was 10%, and cost date was not provided, although cost for peanut OIT compared to standard care requires frequent, time-consuming office visits as opposed to a yearly visit in those not on treatment</p>
<p style="margin: 0in 0in 10pt;">The outcomes of this and other studies looking at peanut OIT must be compared with the current standard of care for peanut allergy:&nbsp; accurate diagnosis, education about avoidance, self-injectable epinephrine.&nbsp; Compared with peanut OIT, current standard care has the following outcomes:&nbsp; incidence of fatal anaphylaxis = 134 deaths/year (vs unknown for peanut OIT), incidence of epinephrine treated reactions = 1.1%/year (vs several on peanut OIT), incidence of EoE is 0.0001%/year (vs 10% on peanut OIT), incidence of remission/cure is 4%/year (vs 85% on peanut OIT, at least for a period and probably declines), and cost is low (vs peanut OIT).</p>
<p style="margin: 0in 0in 10pt;">For these and other reasons, editorials and reviews of peanut OIT to date suggest that this method of treatment for peanut allergy is promising but at this point is not the treatment method of choice.&nbsp; A few such articles and opinions include:</p>
<ol>
<li><i>Wood and Sampson</i> (JACI January 2014):&nbsp; &ldquo;We remain convinced that food OIT is not ready for clinical practice&rdquo;</li>
<li><i>Sampson</i>, Peanut oral immunotherapy:&nbsp; Is it ready for clinical practice? (JACI In Practice, 2013):&nbsp; &ldquo;Although peanut oral immunotherapy shows promise, the evidence currently available on its effectiveness, risk benefit, and potential long-term consequences is insufficient to support its use in clinical practice.&nbsp; Appropriately designed, prospective clinical trials are urgently needed to determine whether oral immunotherapy is a safe, effective form of therapy for food allergy.&rdquo;</li>
<li><i>Nurmatov et al</i>:&nbsp; Cochrane Database &nbsp;Review 2012:&nbsp; &ldquo;Peanut OIT represents a promising, potentially disease-modifying therapeutic approach for the management of IgE-mediated peanut allergy.&nbsp; However, currently there is insufficient evidence in terms of long-term effectiveness, safety, and cost-effectiveness of peanut OIT to recommend its routine use in clinical practice.&rdquo;</li>
<li><i>Cox et al</i> (JACI 2011, AIT practice parameter):&nbsp; &ldquo;The safety and efficacy of oral and sublingual immunotherapy for food hypersensitivity is currently investigational.&rdquo;</li>
</ol>
<p style="margin: 0in 0in 10pt;">We encourage patients to speak with their allergy doctor certified by the American Board of Allergy and Immunology and discuss what may be the best approach for them and their family members regarding peanut allergy.&nbsp; </p>Tue, 21 Oct 2014 00:00:00 -0600